Provider Demographics
NPI:1730175043
Name:RAGSDALE, KEENER B (MD)
Entity type:Individual
Prefix:
First Name:KEENER
Middle Name:B
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BLAKE
Other - Middle Name:
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3249 W SARAZENS CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-0807
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:164 MOUNT PELIA RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3812
Practice Address - Country:US
Practice Address - Phone:731-587-5900
Practice Address - Fax:731-587-5908
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000013458207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN77556OtherBCBSTN
40MD0013458OtherUNITED HEALTH
TN3015256Medicaid
AR112377001Medicaid
MS15175Medicaid
2588782OtherCIGNA
200023248Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3015256Medicaid
TN0003725672Medicare NSC
MS15175Medicaid
TN5198560001Medicare NSC
TN77556OtherBCBSTN
40MD0013458OtherUNITED HEALTH
TN3015255Medicare ID - Type Unspecified
TN3015254Medicare ID - Type Unspecified
A97924Medicare ID - Type UnspecifiedSTERLING MEDICARE
TN3015252Medicare ID - Type Unspecified